Behavioral Health Medical Claims
Resume:
Johnny J. Bethea, II
Durham, NC 27707
ad3e2d@r.postjobfree.com
January 26, 2024
Gree ngs,
I am wri ng to express my interest in the Clinical Pharmacist posi on. With 16 years of experience in popula on health and clinical analy cs and 14 years as a pharmacy manager, I have developed a solid founda on in pa ent care and a commitment to delivering high-quality service. I am eager to contribute my skills and exper se to your team.
Throughout my career, I have developed a strong founda on in developing clinical algorithms for performance measures (CMS, HEDIS, and proprietary) and wri ng clinical considera ons to improve pa ent outcomes. My previous roles have equipped me with proficiencies in fee schedule management, pharmacy and medical claims data, and clinical databases such as SQL, First Databank, and ICD-10. I am accustomed to client-facing and pa ent engagement. My skills align perfectly with the requirements outlined for this posi on.
In my recent role at Relias, I served as a Partner of Behavioral Health Solu ons, contribu ng to mul ple departments, including popula on health, CME content development, accredita on, revenue cycle and codes, sales, engineering, and research. As Pharmacy Manager for Student Health Services at North Carolina Central University, I func oned as an independent pharmacy and provided services to the clinical staff to ensure the safe administra on of medica ons throughout Student Health Services and the Athle c Program. I am confident that my experience and unique skill set as a pharmacist will benefit your team's success and make me a strong candidate for this posi on. Thank you for considering my applica on. I am looking forward to contribu ng to your company. I am available at your earliest convenience for an interview. Please find my resume atached for your review. Warm regards,
Johnny J. Bethea, II
Johnny J. Bethea, II
Durham, NC 919-***-**** ad3e2d@r.postjobfree.com linkedin.com/in/johnny-bethea-ii-pharmacist Pharmacy & Clinical Services Execu ve
Results Driven Clinical Services Execu ve and Licensed Pharmacist with extensive exper se in behavioral health solu ons, popula on health management, and regulatory clinical quality measures. Proven ability to establish posi ve rela onships on various professional and pa ent levels. Skilled in clinical analy cs, medical informa on liaison, and client support. Adept at u lizing SQL for data analysis and interpreta on. Strong background in retail pharmacy management, medica on therapy management, and pharmaceu cal sales. Recognized for excellence in contrac ng and CME accredita on. Trusted clinical consultant providing key insights for client success, commited to advancing pharmacy prac ces through con nuous learning and innova on.
CORE COMPETENCIES
• Clinical Analytics
• Medical Information Liaison
• Project Management
• HEDIS & CQM
• Revenue Cycle & Coding
• Retail Pharmacy Management
• Cross-Functional Teamwork
• Effective Communication
• Medication Therapy
Management
• Contracting
• CME Editor & Accreditation
• Dynamic Leadership
• Pharmaceutical Sales
• Behavioral Health
• Research
• Publications
• FDA Regulations
• HIPAA
• People Operations
• Training & Mentoring
KEY ACCOMPLISHMENTS
• Successful Clinical Project Outcomes: Authored and reviewed 86 Continuing Medical Education (CME) courses, contributing as a Subject Matter Expert, and designed a process to evaluate the success of clinical projects at Relias.
• Health Accessibility Leadership: Expanded health insurance plan acceptance from 2 to over 50 accepted insurances, ensuring accessibility at NC Central University Student Health Services; expanded the Medicaid program for free immunizations and served as the site director for the Vaccines for Children (VFC) program.
PROFESSIONAL EXPERIENCE
Partner, Behavioral Health Solutions Director of Pharmacy, Clinical Services, Relias, Morrisville, NC 10/2018- 12/2023
• Liaised between business intelligence, decision support teams, and clinical services teams to ensure seamless collaboration with behavioral and medical health content development.
• Identifies clinical issues by researching publications, clinical guidelines, FDA approvals, news releases, and medical headlines.
• Acts as a source for drug information to Clinical Analytics and Applications (CAAT), participating in CAAT team meetings and special project meetings and the work of those teams.
• Develop metrics for new measures and client reports. Serve as a clinical consultant to manage client questions concerning selection and outcomes of clinical measures.
• Review and revise dosing guidelines based on a review of the literature and clinical references for appropriate dosing of medications.
• Perform a weekly update and review of DrugMaster tables and other information sources to ensure drug-related data accuracy and completeness. Ensure that dose guidelines are up to date and in accordance with literature and clinical references.
• Review the Outcomes request for validity and suggest alternative methods to evaluate data.
• On an annual basis, chair the Project Team for updating Health Alerts, including researching necessary updates, reviewing with the clinical team, and submitting to IT for Production.
• Review the coding of developers to ensure that it performed to clinical specifications.
• Perform periodic reviews of standard reports by randomly selecting prescriber mailings, writing queries to extract data from client databases, and validating the patients identified by the clinical measures.
• Design test cases for QA associates that will uncover any inaccuracies related to clinical measures, DrugMaster, and special projects. Act as a consultant for QA associates and other workgroups. Performs in-service to train associates on drug databases.
• Screens potential business deals by analyzing market strategies and deal requirements, evaluating options, and resolving internal priorities.
• Studying integration of new venture with company strategies and operations; examining risks and potentials; estimating partners' needs and goals.
JOHNNY J. BETHEA, II
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• Serve as a Subject Matter Expert (SME), review and ensure the quality of continuing education content, contributing editor for CME courses, ensuring accuracy and relevance in alignment with healthcare industry standards. Serve on the accreditation committee.
• Enhance the organization's reputation by accepting ownership for accomplishing new and different requests and exploring opportunities to add value to job accomplishments.
Director of Pharmacy, Clinical Services, Relias (formerly Care Management Technologies, Inc), Morrisville, NC 6/2007- 10/2018
• Engaged as the sole pharmacist within the company, working closely with a multidisciplinary team, including psychologists, and leading the clinical team.
• Acted as a liaison between the IT department's technical and medical specifications, facilitating effective communication between the clinical and technical teams.
• Demonstrated proficiency in reading and deciphering IT code, ensuring alignment with team objectives and desired outcomes.
• I transitioned from full-time to part-time from October 2011 to October 2018. Pharmacy Manager, North Carolina Central University Student Health Services, Durham, NC 11/2012- 10/2018
• Manage the university pharmacy, overseeing all aspects of operations, including inventory management, medication therapy management, and adherence to HIPAA compliance standards as the HIPPA compliance officer for the whole university.
• Serve as an administrator of the Electronic Health Record (EHR), ensuring accurate and secure digital records.
• Collaborate in a 1:1 capacity with pharmacy student interns, providing hands-on training and mentorship to future pharmacists.
• Develop and implement policies, procedures, and protocols to ensure safe medication administration.
• Establish protocols for vaccine administration.
• Expand pharmacy revenue by establishing contracts with private health insurance.
• Manage Medicaid contracts and expand coverage for medical services. Serve as administrator for the Vaccines for Children (VFC) program.
• Co-administer the PrEP HIV prevention program.
Pharmacy Manager, Harris Teeter Pharmacy, Apex, NC 10/2011- 11/2012
• Managed pharmacists and technicians, maintained inventory, and ensured accurate patient records.
• Provided MTM and influenza vaccinations.
• Served as a preceptor for pharmacy students.
• Developed corporate pharmacy policies and procedures. Pharmacy Manager, Harris Teeter Pharmacy, Durham, NC 12/2000- 6/2007
• Manage pharmacists and technicians, maintained inventory, and ensured accurate patient records.
• Provide MTM and influenza vaccinations.
• Served as a preceptor for pharmacy students.
• Developed corporate pharmacy policies and procedures. Psychiatric and Cardiovascular Medical Consultant, PPD Medical Communications Division, Durham, NC 10/1997- 9/1999
• Specialized in cardiovascular disease and psychiatric disorders.
• Respond accurately and professionally to technical and medical information inquiries from healthcare professionals and consumers. Process fulfillments and provide clinical trial information.
• Analyzes callers' questions to formulate concise responses using client-approved resources and records inquiries and interactions in the appropriate databases following organizational, client, and regulatory guidelines. ADDITIONAL EXPERIENCE
Pharmacy Manager, Eckerd Drug, Raleigh, NC 2/1996 – 10/1997 Relief Pharmacist, Eckerd Drug, Raleigh, NC 10/1997 – 3/1999 Pharmaceutical Representative, Eli Lilly and Company, Durham, NC 9/1992 – 1/1996 Inpatient Staff Pharmacist, McLeod Regional Hospital Florence, SC 6/1992 – 9/1992 EDUCATION
Medical University of South Carolina
Bachelor of Science in Pharmacy 05/1992
JOHNNY J. BETHEA, II
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CERTIFICATIONS & TRAINING
• Pharmacy Informatics Certificate, ASHP
• Medication Therapy Management Certificate
• Pharmacy-Based Immunization Delivery Certificate, APhA
• Pharmacists Virtual Training Program for Long-Acting Injectables, Campbell University College of Pharmacy and Health Sciences
• Asthma Certificate, Area L AHEC
PUBLICATIONS & PRESENTATIONS
• Keynote Speaker, MUSC College of Pharmacy White Coat Ceremony, 2023
• Best Prac ces in An psycho c Prescribing CME Webinar, Missouri Healthnet, 2023
• Improving maternal mental health: assessing the extent of screening and training about peripartum depression, The Journal of Maternal- Fetal & Neonatal Medicine, December 12, 2022
• Behavioral Health Diagnoses and Health Care Use Before and During the COVID-19 Pandemic, Psychiatric Services, January 7, 2022
• An bio c Stewardship Webinar, Illinois Department of Human Services, Department of Mental Health · July 27, 2017 AWARDS & AFFILIATIONS
• American Society of Health-System Pharmacists
• North Carolina Associa on of Pharmacists
• Board of Directors and Execu ve Commitee - Lincoln Health Center, Durham, NC
• Dean's Advisory Council Member, Building Leadership Commitee - Medical University of South Carolina, College of Pharmacy
• MUSC College of Pharmacy Career Mentorship Program.
• Preceptor for UNC Eshelman School of Pharmacy - Advanced Community Pharmacy Prac ce (APPE)
• Board Member & Chairman, Formulary Commitee - Senior PharmAssist - 2005 - 2011
• Honored with the crea on of the Johnny Bethea II needs-based scholarship at the MUSC College of Pharmacy - 2021
• Open Minds and Janssen's Behavioral Health Organiza on (BHO) Advisory Board - October 2021
• Principal Inves gator for ABC Program Alcohol Preven on and Interven on Program for Youth - 2014-2017 TECHNICAL SKILLS
• Microsoft Office Suite
• Power BI
• QuickBase
• EHR - Medicat
• SQL
• Highspot
29 December 2023
To Whom It May Concern,
I am wri ng this leter as support for Johnny Bethea’s applica on for employment. I have been fortunate to work with Johnny over 15 years as colleague and some of that me as his manager. By way of background I am the former Commission of Mental Health for the State of Illinois. Following my work in state government I was employed by Comprehensive Neuroscience where I met Johnny. Our company ul mately was bought by Relias and both Johnny and I went to work for Relias. Johnny and I have worked together over these years on an analy c product which gathered companies, agencies, and state’s data in order to determine their adherence to evidence based prac ces. Our tasks included working with our customers to understand their complicated data sets, loading their data into our systems and resolving problems, developing and maintaining our algorithms in order to be able to provide state of the art feedback on evidence based prac ces. Needless to say this is enormously detained work and requires the utmost exper se in not only data analysis but also clinical knowledge. Johnny and I worked on a variety of other educa onal projects together and in all of this work Johnny’s exper se and professionalism has proven to be invaluable. He was the heart of this data analy c system and his exper se was absolutely necessary in order for the system to operate and have integrity. He is an excep onal professional whose font of knowledge is enormous and his willingness and ability to learn is great. He is ethical and a great colleague. I am happy to provide any addi onal informa on that would benefit you. Sincerely
Leigh Steiner, Ph.D.
ad3e2d@r.postjobfree.com
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